Breathing therapy apparatus



Nov. 6, 1934. MC:KES$ON 1,979,981

BREATH ING THERAPY APPARATUS Filed Jan. 2, 1932 5 Sheets-Sheet l Nov. 6, 1934.

E. l. M KESSON BREATHING THERAPY APPARATUS Filed Jan.. 2, 1932 5 Sheets-Sheet 3 6, 1934- E. l. M KESSON 1,979,981

I BREATHING THERAPY APPARATUS Filed 'Jan. 2, 1932 5 Sheets-Sheet 4 Nov. 6, 1934.

Filed Jan. 2: 1952 '5 Sheets-Sheet 5 gwowntoz u I H W Patented Nov. 6, 1934 AWN FQE BREATHING THERAPY APPARATUS Elmer lI. Mclides Application January 2,

t Claims.

This invention relates to controlling the atmosphere to a patient.

This invention has utility when incorporated in oxygen therapy.

Referring to the drawings:

Fig. 1 is a disclosure, with parts broken away, of an embodiment of the apparatus for treating a patient, say afiiicted with pneumonia;

Fig. 2 is a view on an enlarged scale on the line IIII, Fig. 1, looking in the direction of the arrow;

Fig. 3 is a section on the line IIIIII, Fig. 1;

Fig. 4 is a section on the line IV-IV, Fig. 3, with the cover for the pump removed;

Fig. 5 is a section on the line V-V, Fig. 3;

Fig. 6 is a section on the line V'I--VI, Fig. 3;

Fig. '7 is a section on the line VII-VII, Fig. 5;

Fig. 8 is a fragmentary view, in side elevation, from the right of Fig. 3, of the control valve and adjacent parts;

Fig. 9 is a section on the line IX-IX, Fig. 8, of the control valve plug;

Fig. 10 is a section on the line X-X, Fig. 9, lengthwise of the control valve plug;

Fig. 11 is a section on the line X1Xi, Fig. 10, of the supply valve porting to the control valve;

Fig. 12 is a section on the line XIIX1I, Fig. 10, of the direct supply port;

Fig. 13 is a section on the line XIIIXIII, Fig. 10, of the ports, showing the supply port to this control plug valve in the return from the automatic valve supplied by the ports at the section (Fig. 11)

Fig. 14 is a section on the line XIV-15V, Fig. 10, of the ports for the upper or minor cylinder control;

Fig. 15 is a section on the line XV-XV, Fig. 10, of the ports for the lower or major cylinder control;

Fig. 16 is a view of an embodiment of the automatic valve and single cylinder in a movable mounting therefor, instead of rigid as shown in Fig. 3; and

Fig. 17 is a vertical section through the expansible chamber of the device of Fig. 16.

Pressure cylinder 1, as a storage chamber for oxygen pressure, is provided with outlet valve 2 connected to adjustable reducing valve 3. The extent of pressure in the tank 1 as disclosed by gauge 4. The adjustment of the valve 3 may be such as to determine the variation in the rate of delivery of the gas as disclosed by gauge 5', say

' as to the extent of the reduced pressure. From this gauge 5 and the regulator valve 3, there extends duct 6, connected by fitting 7 to casing 8,

son, Toledo, ()hio 1932, Serial No. 584,317

in which is located plug 9 as a manual control valve. This plug 9 has central chamber portion 10 from which radiate ports 11, 12, 13, 14, in a common plane (Figs. 10, 11). These ports are 90 apart. This plug 9 has upwardly extending therefrom stem 15 terminating in handle 16, below which is pointer 17 (Figs. 1, 2). With the pointer 17 at position A, the point 11 is in communication with the duct 6, and is connected for pressure gas flow through port 13 into duct 18 (Figs. 6, 9).

This duct 18 extends to valve housing 19, in which is located piston 20 as a valve control plunger. In its upper position groove 21 cuts off flow from the duct 18. In the lower position of this plunger 20, the duct 18 may have flow therefrom by way of the groove 21 to passage 22, upwardly in this valve casing 19 to duct 23. Thisduct 23 extends to the casing 8 and is there in register with port 24 (Figs. 10, 13) for flow into aligned passage 25 in the plug 9 and thence by way of port 26 to duct 27 (Figs. 3, 5, 9, 14) to the lower portion of cylinder 28, having lower cylinder head 29 and upper cylinder head 30.

In this cylinder 28 is piston 31, below which piston 31 this duct 27 delivers gas pressure to urge this piston 31 upward. In this upward travel, the piston 31 moves piston rod 32. This piston rod 32 extends upward through the cylinder head 30 and therebeyond terminates in seat or tapered portion 33. This seat 33 may rest in handle 34 of partition 35, having depending side wall 36 forming a bell. The depending side 36 enters liquid as water 37 between inner wall 38, having bottom 39 extending to outer wall 40, on which this inner wall 38 is mounted. This outer wall 40 extends to bottom 41. These walls 40, 41, have insulation 42 thereabout to outer jacket 43 mounted on swivel casters 44. There is provided a readily shiftable or transportable chamber of heat holding or heat transference resistant capacity.

The cylinder head 30 has an upward extension 45 on which is mounted bracket 46, positioning the valve casing 19. The piston rod 32 in extending upward beyond the cylinder head extension 45 there carries bracket 47 from which dependsstem 48, having collars 49, 50, thereon adjustably mounted by set screws 51. In this ascent of the piston 31 and its rod 32,. the collar 49 strikes lever 52, mounted on fixed pivot 53 (Figs. 3, 4). As this lever 52 is moved upward, tension spring 54 becomes effective to act on minor lever 55, having fixed fulcrum 56 in bracket 57 fixed with the casing 19.

There thus is effected a quick or snap throwing of the minor lever connected by pivot pins 56 with yoke 57 through stem 58. Nut 59 on this stem 58 (Fig. 6) determines the limit of throw for this plunger to bring the groove 21 out of register with the duct 18, and groove 60 in this plunger 20 into register with the duct 23. This cuts off the flow of the pressure oxygen into the cylinder 28 below the piston 31, and simultaneously connects the duct 23 for exhaust operation.

The load of the bell in this gasometer device having a water seal connection thus causes descent of the piston 31 and its charge say 400 cc. of oxygen to flow into the duct 27 by way of the port 26, way 25, port 24, and the duct 23, to the valve casing 19, and by way of groove 60 to duct 61 into mufiier 62, having charge of fibrous material 63 therein. This mufiier thus delivers the exhaust from the spill of the cylinder and piston device 28, 31, into central chamber 64 (Fig. 3). This central chamber 64 is under the bell 35, 36 (Fig. 3). This gas replenishment of oxygen to this chamber 64 is in communication with chamber 65 inward from the moat or water seal by way of opening 66 through lid 67. This lid 67 is merely a shield or protection against ice 68 in the lower part of the chamber 65 getting tumbled into the engine mechanism.

From this chamber 64, there is lateral way 69 to side plate '70 mounting the valve casing 8. This plate '70 has port '71 to fitting 72 for riser pipe 73 (Figs. 3, 8). This riser 73 has flexible extension '74 (Fig. 1) connected to fitting '75 in the upper region of tent '76, having transparency or window portion '77. This tent is suspended by hook '78 from arm '79, carried by upper section 80, telescopically adjusted by set screw 81 -into lower tubular section 82, mounted by bracket83 with the casing 43, and bracket 84 with the face plate 70.

A patient 85 in bed 86, equipped with mattress 8'7, is located upon said mattress after the mattress is covered with gas flow resistant member or rubber sheeting 88. Tent sides 89 are tuckedin about the mattress 87 back of the patients head and along the sides of the bed with the portion of the tent toward the feet of the patient being loose, and resting with the coverletsthereover. This latter sheeting side provides the region for gas seepage or gradual escape. Accordingly in the control, there may be pulsation rate of say ten 400 cc. engine exhausts perminute into this tent '76. This air is conditioned by the ice 68. It is to be noted these replenishment cha'rges from the motor are in synchronism with the motor operation.

Furthermore, the effectiveness of the replenishment is accentuated, due to the fact that the exhaust is into the system or way including the tent at the interval of the lowering of the bell which transmits the counter-pulsing action of way to drive air from the chambers 65, 64, by way of the passage 73, '74, into the tent '76. This pulsing supply may be independent of the inhalation and exhalation rate of the patient 85.

The patient, especially if afiiicted with pneumonia, has a temperature which would tend to discomfort. The supply of the oxygen enriched air at the lowered temperature of as little as 4 or 5 degrees has a buoying-up tendency which counter-acts depression of the patient notwithstanding the high temperature of exhalation gases from the patient. Exhaled air from the lungs is saturated with aqueous vapor. The

cooling of the exhaled air removes some of the water vapor, which upon re-inhalation affords means for removing water from the lungs. The continued respiration of air or oxygen, saturated with aqueous vapor, is depressing to a patient whose lungs are more or less filled with liquids, as in pneumonia. Cooling the exhaled gases is a satisfactory means of reducing the relative humidity for gases to be reinhaled, relieving the depression from the breathing of water-saturated air or oxygen. These exhalation gases from the patient are dissipated in the enriched mixture and surplus of exhalation gradually leaks out from the covers and the tent side of the patient, say toward the foot of the bed. The rapidity of pulsations of the pump may be checked by shifting the pointer 1'7 a slight distance either way from the position of exact register A (Fig. 2). In the event it is desired to increase the volume of replenishment to the patient, this may be effected by turning the pointer 17 to register with B" (Fig. 2). This counter-clockwise shifting brings port 14 into register with the supply duct 6 and permits flow by way of the port 12 into the duct 18 to the automatic control valve 19, 20, to operate in supplying this gas by way of the duct 23 and by way of port 89' (Fig. 13) into the way 25.

At this position of the plug 9, by-pass port 90 is in register with the duct 2'7, and spill-port 91 so that reciprocation of the piston 31 in the cylinder 28 is idle, and that the port 91 allows air from the chamber 64 to be drawn readily into the cylinder 28 upon the up-stroke, and as readily discharged from the cylinder 28 on the down-stroke.

At this position, the pressure air supply into the way 25 is by the port 89'. Such pressure air may flow by port 92 (Fig. 15) into duct 93 (Figs. 3, 9) to the lower portion of cylinder 94, having therein piston 95. Base cylinder head 29 for the cylinder 28 is the upper cylinder head for this cylinder 94. Base 96 provides a bottom cylinder head for this cylinder 94, which is connected by bolts 9'7 (Fig. 3) in anchoring the engine mechanism with the bottom wall 41 and shell 43 of this main chamber. With this cylinder 94 of say 600 cc. capacity, and the same number of pulsations per minute be retained as for the piston 31, there is accordingly a increase in the volume of the gas delivered. The delivery of this gas occurs after the snap throwing at the automatic valve 18, 19, and there is thus reverse flow in the duct 93 back to the plug 9 through the port 89', way 25, port 92, duct 2'7, groove 60, and duct 61 into the muffler 62.

The volume of this gas flow may be further increased notwithstanding there be but the two cylinders, and this is efiected by having these cylinders 28, 94, act in tandem. This is effected by shifting the pointer 17 (Fig. 2) to register C." The plug valve 9 is thus located to bring port 98 (Fig. 13) into registry with the duct 23. At this position, port 99 (Fig. 14) and port 100 (Fig. 15) are respectively in register with the ducts 2'7, 93. This means that the pressure oxygen supply is simultaneously deli ered to the under sides of the pistons 31, 95, and their joint action lifts the bell 35, 36. The automatic valve snaps at the lever device 52, 55, for the simultaneous automatic cut-ofi of the supply of the pressure gas, and there is then the valve setting for both cylinders to exhaust simultaneously by way of the mufiier 62. At the position for operation of the cylinder device 28, 31, there should normally be no occasion for any shifting of the piston 95 because piston rod 101 is entirely independent of the piston rod 32, although it is aligned therewith, and protrudes through the cylinder head 29 to contact with the piston 31.

Should there be any tendency for-this piston 95 to shift, there is no pulsing action in the way of suction or pressure to result therefrom, for at the position of the plug 9 for the operation of the pump 28, 31, by-pass port 102 (Figs. 9, 15) connects the duct 93 with the port 91 for direct communication with the chamber 64.

.It is pointed out that as to the pointer 17, the full capacity positions are 90 apart, directly upon the respective letters, A,-B, C. For

variation, this pointer 17 (Fig. 2) at dial 103 may be shifted away from the 90 ratio position, and this will reduce the pulsing rate and accordingly directly increase the time volume for the respective pulsing actions. In the event it should be desired to resuscitate the patient, or there be other occasion for delivering oxygen into the way involving the variable capacity chamber and the communication therebetween, the pointer 17 may be shifted to direct (Fig. 2). This position of the pointer 17 locates the plug valve 9 for the port 12 communication with central Way 10 (Figs. 9, 10, 11, 12) and port 104 in register with spill port 105 in the casing 8.

i There is thus a direct supply of oxygen from the cylinder 1 at the reduced pressure directly in the way of themechanism of this disclosure at the controlled rate determined by the adjustment of the valve 9 on or partially 011' "direct, and the pressure drop determined by the regulator 3. This is a continuous flow independent of any pulsation and may be cut ofl as the emergency therefor has passed. This also may be used for initially charging the chamber and tent before the motor mechanism is brought into play for the automatic replenishment over an interval of time.

Modification of the pure oxygen supply may arise. For, instance, an excitant to promote respiration action may be used. Carbon dioxid serves such end. With this purpose in view, bracket 1% (Fig. 1) may mount pressure cylinder 106 of carbon dioxid. Valve 107 may be opened for delivery of the carbon dioxid under pressure to reducing valve 108.

Gauge 109 may show the pressure in the cylinder 106. Gauge 110 may disclose the approximate rate of flow, say in liters per minute, of

the carbon dioxid at thereduced pressure from the reducing valve 108 by way of duct 111, past adjustable valve 112, into the way 69, in communication with the chambers 64, 65.

Drain valve 113 (Fig. 3) may be opened to lower the level of the water 37 in the moat or for draining such chamber. Drain cock 114 (Fig. 1) may be opened to draw off the water from the melting of the ice 68, condensation and water or liquid drawn off from the moat. This valve 114 may be manually controlled at the desired intervals.

Protruding through opening 115, in the shield 67, are a plurality of oil supply ducts. Duct 116 extends to the casing 19 to lubricate the plunger 20. Duct 117 extends to extension 45 to lubricate the piston rod 32 at the cylinderhead 30 (Figs. 3, 5, 6). Duct 118 extends to the cylinder head 29 to lubricate the piston rod 101. The adjusted position for the stem 15 (Fig. 3) againstshifti'ng, as to the dial 103, in locating the pointer 17, is determined and held by the friction action of spring 119, between collar 120,

adjusted by set screw 121 in its holding action,

and the bracket 83 through which extends telescopic column section 82 and the riser duct 73.

Should there be operation of this installation over long intervals of time, or if there be occasion involving replenishment of the water 37 in the moat, level therefor may be automatically retained by a pump connected to be operated by the piston rod 32. To this end the bracket 47 has extension 122 with set screw 123 anchoring piston rod 124 therewith. This piston rod 124 extends through gland 125 into cylinder 126 (Figs. 5, 7) to piston 127 having check valve 128. This cylinder 126 has foot valve 129 in cylinder head 130.

Water from the melting of ice 68 may fiOW by way of passage 131 to the valve 129 and this pump may be efl ective to lift such water in the cylinder 128 for flow by passage 132 into the moat. This supply water to the moat may overflow from this moat back into the chamber 65.

The general chamber or casing of this housing 43 is provided with vents 133 (Fig. 3) so that there is no resistance to the operation of the bell 35, 36, when cover 134 is in place. This insulated cover 134 and the insulated side wall tend to hold the cooling medium for eificient operation of this device.

Casters 44 may mount insulation box or chamber 145 (Figs. 16, 17). This insulation chamber 145 is shown with moat 146, having drain cock 113 into cooling chamber 147, in which may be placed block of ice 148. Drain cock 114 may draw 0E the water from the melting ice as well as water drained from the moat into this chamber 147, by way of the cock 113. This chamber 145 is provided with pivot bearing 149, mounting bell 150 on such pivot to swing into and out of this moat 146. There is thus provided an expansible or variable capacity chamber with water seal at the joint. This chamberhas takeoff duct 151, to which may be connected flex-- ible extension or hose 74 to the tent or other connection in the respiratory use of this device. Bolts 152 mount arc 153, fixed with the section 150 of this chamber. This are bracket 153 is provided with a plurality of notches 154. 155, 156, 157. Into a selected notch of this are bracket 153 may be thrust pin 158, fixed with piston rod 32, protruding from the extension 45 of cylinder head 30, past cylinder 159, having therein piston 160. This cylinder 159 has head 161, mounted on pivot pin 162, fixed to the housing 145. Oxygen supply duct 6, instead of go ing into the plug valve 9, may extend directly to valve casing 19 and be effective as the duct 18. From this automatic valve 19, 20, the duct- 23 extends to the cylinder 159 on the side of the piston 160 toward the head 161 to thrust the piston rod 32 outward, and as this movement into a notch at the bracket 153 is effective, there is a lifting of the chamber 150 in increasing the capacity of this chamber.

The limit of this movement is determined by the collars on the stem 48, effecting tripping of the snap for reversing the valve 19, 20. The weight of the chamber section 150 in causing the piston 160 to move toward the piston head 161 causes the oxygen flow in the line 23 to the valve 19, 20, and therefrom by way of flexible duct 163 to fitting 164, for exhausting into the chamber 147. As the pin 158 is located farther from the pivot bearing 143 for the section 150,-

the lift is less great, and accordingly the increase in the pulsation volume is reduced as to the acriation in the capacity for the pulsation in these adjustments of the cylinder 159, rocking on the fulcrum pin 152 at the different adjustments. The pulsation rate is adjusted by adjusting the valve 3 on the supply cylinder 1. The length of stroke for the'piston 160 is adjusted by the set screws 51 adjusting the collars 49, 50.

It is to be noted that the devices of this disclosure involve a bellows and that in the opera.- tion of such bellows from the gas motor, pulsing is effected in the way to the patient. These pulsations may be adjusted in the control of the regulator valve as to the pressure in a range of from 10 to 20 pulsations per minute, or the pulsation rate may be slowed up at the slow indications for the pointer 1'7 on the dial 103 (Fig. 2). The bellows chambers may be of various forms, even cylindrical, but in the types disclosed, rectangular form has been adopted. The general dimension of the embodiment, say in Fig. 1, may be for the bell or bellows in its stroke, to pull in, say 25 liters from the tent '76. This pull is a pulsing through the duct '74 to the bellows from the tent, in the ascent of the bell with counterflow in the descent of the bell.

During this descent, the exhaust from the motor spills into the way in promoting commingling for uniform character of the breathing medium for the patient. This is an effective ventilation for the tent. The efiiciency is further accentuated for the excessive moisture carried by the exhalation from the patient, approaching saturation at the higher or fever temperatures as drawn into the bellows, has its temperature reduced for condensation of the excess moisture. Furthermore, the exposed moist surfaces of the chilling medium are absorbent for undesirable portions of the exhalation as carbon dioxid. The spill of the gas back into the tent may be of a ratio for definite enrichment, due to the peculiar condition of the patient undergoing treatment. The stroke may be, in this replenishment, say the 400 cc. for the upper cylinder 28 stroke, 600 cc. for the lower cylinder 94 stroke, or one liter for the combined cylinders. The pulsations per minute may be varied as to each of these capacities for replenishment, and the surplus spills or seeps out from the tent side of the patient toward the foot of the bed.

What is claimed and it is desired to secure by United States Letters Patent is:

1. Respiratory apparatus embodying an exp'ansible chamber, a conduit-for connecting the chamber with the respiratory organs of a pa tient, means intermittently expanding and contracting said chamber in cycles at a rate independent of the rate of respiratory effort of the patient, a supply of respirable gas, and means communicating with said supply and said chamber and actuated by the chamber expanding and contracting means for introducing gas from said supply into said chamber in gusts in step with the cycles of the expanding and contracting of said chamber.

2. Respiratory apparatus embodying an expansible chamber, a conduit for connecting the chamber with the respiratory organs of a patient, a pneumatic motor intermittently expanding and contracting said chamber in cycles at a rate independent of the rate of respiratory effort of the patient, a supply of respirable gas, and means communicating with said supply and said chamber and actuated by the motor for introducing exhaust gas from the motor into said chamber in gusts in step with the cycles of the expanding and contracting of said chamber.

I 3. Respiratory apparatus embodying an expansible chamber, a conduit for connecting the chamber with the respiratory organs of a patient, a reciprocating pneumatic motor intermittently expanding and contracting said chamber in cycles at a rate independent of the rate of respiratory effort of the patient, a supply of respirable gas, means communicating with said supply and said chamber and actuated by the motor for introducing exhaust gas from the motor into said chamber in gusts in step with the cycles of the expanding and contracting of said chamber, and manually adjustable means for the motor to vary the gas volume delivery by the motor to the chamber.

4. Respiratory apparatus embodying an expansible chamber, a conduit for connecting the chamber with the respiratory organs of a patient, a multi-cylinder pneumatic motor for intermittently expanding and contracting said chamber in cycles at a rate independent of the rate of respiratory eifort of the patient, a supply of respirable gas, means communicating with said supply and said chamber and actuated by the motor for introducing gas from said supply into said chamber in gusts in step with the cycles of the expanding and contracting of said chamber, and selecting means for using one or more of the cylinders of the motor for. varying the gas volume delivery by the motor to the chamber.

5. Respiratory apparatus embodying a source of respirable gas, a conduit for communication with the respiratory organs of a patient, a chamber adapted to contain a body of respirable gas, said chamber communicating with said conduit, means for alternately pumping and withdrawing gas in successive cycles through said conduit to and from the patient respectively, and automatic means for intermittently replenishing the body of respirable gas from 'said source in step with said cycles.

ELIVIER I. MCKESSON.

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